MEDICARE: ADAM D BLOEMKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	49284	MN

General Provider Information

NPI Number	:	1194923383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM D BLOEMKE M.D.

Provider Business Mailing Address
First Line	:	8100 W 78TH ST STE 225
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55439-2569
Country	:	US
Telephone Number	:	952-946-9777
Fax Number	:	952-946-9888

Provider Business Practice Location Address
First Line	:	11850 BLACKFOOT ST NW STE 450
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-2773
Country	:	US
Telephone Number	:	763-236-0800
Fax Number	:	763-236-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	11/10/2020

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